Healthcare Provider Details

I. General information

NPI: 1144476631
Provider Name (Legal Business Name): ROBIN L MOORE MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROBIN L WILLIAMS MS,OTR/L

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 09/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 N WALNUT RD
ROCHESTER IL
62563-8444
US

IV. Provider business mailing address

2437 E KEYS AVE
SPRINGFIELD IL
62702-3207
US

V. Phone/Fax

Practice location:
  • Phone: 217-299-0952
  • Fax: 217-679-2497
Mailing address:
  • Phone: 217-299-0952
  • Fax: 217-679-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056005705
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: